NPIMap

Organization Active NPI

Jefferson Comprehensive Care System, Inc

  • Federally Qualified Health Center (FQHC)
  • Redfield, AR
National Provider Identifier
1124224928
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Practice address
113 W River Rd
Redfield, AR 72132
Phone
(501) 397-2261
Fax
(501) 397-2263
NPI assigned
Jun 27, 2007
Organization subpart
Yes
Parent organization
JEFFERSON COMPREHENSIVE CARE SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Larnell W Davis
Title
Executive Director
Phone
(870) 543-2380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

113 W River Rd
Redfield, AR 72132

Mailing address

PO Box 1285
Pine Bluff, AR 71613-1285
Phone (870) 543-2380

Other identifiers 1

IdentifierTypeStateIssuer
122635749MedicaidAR

Other names 1

  • Redfield Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040603001458 AR Part B Supplier - Clinic/Group Practice 5193634509 Receives reassigned benefits from 22 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altheimer, AR; Redfield, AR; Pine Bluff, AR; North Little Rock, AR; Little Rock, AR; College Station, AR
O20100614000457 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193634509 Practice locations: Redfield, AR

Federally qualified health center certification: CCN 041820

Legal name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Doing business as
REDFIELD CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1994 in AR
Enrollment address
823 River Rd
Redfield, AR 72132-9667

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0858679Redfield Clinic823 River Road, Redfield, AR 72132Provider-performed microscopyJan 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pine Bluff Health Clinic12 organizations share this tax ID, including this one
Part of
Pine Bluff Health Clinic

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lillie Reeves Individual Corporate OfficerBoard Member Feb 1, 2013 1.47%
Eduardo R. Ochoa Individual Corporate OfficerBoard Member Feb 1, 2013 1.47%
Belinda Jones Individual Corporate Director Feb 16, 2010
Bonita Corbin Individual Corporate Director Feb 16, 2010
Chanda Evans-McField Individual Corporate OfficerC.F.O. Sep 1, 2009 1.47%
Albert Lowery Individual Corporate Director Feb 1, 2010
Sandra J Brown Individual Corporate Director Sep 18, 2012
W-2 Managing Employee Mar 10, 2010
Leila Alston Individual Corporate OfficerBoard Member Feb 1, 2010 1.47%
Thelma Flournoy Individual Corporate Director Feb 16, 2010
Jeremy Lambert Individual Corporate Director Feb 16, 2010
Patricia a Washington Individual Corporate Director May 13, 2013
W-2 Managing Employee May 13, 2013
Stephanie Stanton Individual Corporate OfficerBoard Member Feb 16, 2010 1.47%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Downtown Little Rock Community Health CenterLittle Rock, AR, CCN 041055 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972
Jefferson Comprehensive Care System, IncLittle Rock, AR, CCN 041051 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1124224928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1285",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131285",
            "telephone_number": "870-543-2380",
            "fax_number": "870-536-5581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W RIVER RD",
            "city": "REDFIELD",
            "state": "AR",
            "postal_code": "72132",
            "telephone_number": "501-397-2261",
            "fax_number": "501-397-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LARNELL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "870-543-2380",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122635749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redfield Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redfield, AR

Sources for this page

Verify at the official NPI Registry.